Gastric xanthelasma associated with hyperplastic polyp and mucosal erosions: report of an unusual case and literature review

Abstract

Gastric xanthelasma is a rare benign tumor-like lesion which is usually observed as an incidental finding due to its asymptomatic presentation. Grossly, it is a well-demarcated yellow-white plaque which is microscopically formed by clusters of foamy macrophages in the lamina propria. The pathogenesis and clinical significance are not clear. Gastric hyperplastic polyps are rarely associated with xanthelasma. Mucosal erosions also appear to have an association with the combined lesions of hyperplastic polyp and xanthelasma. Here, we report a rare case of simultaneous occurrence of gastric xanthoma with hyperplastic polyp and mucosal erosions. The lesions are observed in a 78 years old male who presented with a history of chronic anemia. The histological features together with a literature review of other similar reported cases are described and compared.

Figure 1:

(a) Endoscopic images of gastric lesions. The upper two endoscopic images showing the same yellow-white gastric lesion at the gastric fundus measuring 0.7 cm. The lower two endoscopic images showing a single pedunculated gastric polyp at the antrum measuring 1.0 cm. (b) Photograph of the gastric biopsy showing a large aggregate of foamy macrophages with adjacent inflamed mucosa (H&E stain ×200). (c) Inflamed gastric mucosa showing numerous foamy macrophages consistent with xanthoma in the gastric lamina propria. Note the presence of active acute on chronic gastritis in the adjacent gastric glands (H&E stain ×200). (d) Low power microscopic view of gastric polyp (H&E stain ×40). (e) Inflamed gastric hyperplastic polyp containing cystic glands lined by clear Parietal cells. Note the presence of goblet cells in the upper left side of the picture which is indicative of intestinal metaplasia (H&E stain ×100).